| NPI | 1275842726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 94) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA-76) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2022-08-15 |