| NPI | 1447286083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 70) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 002977) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2021-03-18 |