| NPI | 1417086786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 002173) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002173) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-10-01 |