| NPI | 1376885970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 81) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 006764) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2022-01-26 |