| NPI | 1215170584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX AA844) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: 844) |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA213) | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2020-09-02 |