| NPI | 1275896367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 91-017) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1343) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2021-11-22 |