| NPI | 1235382185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA753) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1821) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2023-03-13 |