| NPI | 1245611086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MI 1877) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000251) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2024-04-02 |