| NPI | 1235792011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000225) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2023-11-21 |