| NPI | 1215924527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000176A) |
| 183500000X Pharmacist (Licence: FL ps40328) | |
| 183500000X Pharmacist (Licence: NC 17641) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2024-05-10 |