| NPI | 1346492428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 96) |
| Additional Taxonomies | 174400000X Specialist (Licence: DC AA000016) |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA121) | |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2022-10-27 |