| NPI | 1336104942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 235) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: AL AA827) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2022-06-04 |