| NPI | 1366743320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1099) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1099) |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2022-01-27 |