| NPI | 1447564158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA299) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 5934) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2025-03-28 |