| NPI | 1366840241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NC 1000-00667) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 7445) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2017-02-22 |