| NPI | 1356624803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000048A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000188) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2022-10-12 |