| NPI | 1285747378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MI 263) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601001816) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-03-04 |