| NPI | 1346557949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2010029842) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2016-08-02 |