| NPI | 1245512870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA 337) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2011029434) |
| 367H00000X Anesthesiologist Assistant (Licence: NM AA2013-001) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2016-08-30 |