| NPI | 1346618493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA268) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 53) |
| Enumeration Date | 2015-09-07 |
| Last Update Date | 2015-09-07 |