| NPI | 1215335518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: DC 1727) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000049) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2014-12-18 |