| NPI | 1275584310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 004351) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 004351) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2013-06-25 |