| NPI | 1326235474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 1945) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 001945) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 001945) | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2023-02-13 |