| NPI | 1396147336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 7291) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 007291) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2023-02-01 |