| NPI | 1326349390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000051) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1140) |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2019-11-20 |