| NPI | 1396996864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA649) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 005423) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2021-07-28 |