| NPI | 1275676538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA328) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000103) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2016-10-10 |