| NPI | 1437824273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA672) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-09-15 |