| NPI | 1396996492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MI 909) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000032) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 005462) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2023-02-15 |