| NPI | 1255640587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000024) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 005942) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2014-01-22 |