| NPI | 1346761202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000303) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2019-07-19 |