NPI | 1417086612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 001840) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 001840) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2010-10-06 |