| NPI | 1215969951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA498) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: VT 135.0000036) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 003913) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-09-23 |