| NPI | 1306181276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000035) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA155) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2024-01-09 |