| NPI | 1245276278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MD c02961) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-06-01 |