| NPI | 1265780092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000129) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2012029913) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2020-04-17 |