| NPI | 1225446537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000138) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2014026440) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2020-11-17 |