| NPI | 1447637871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000109) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 63-17) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2019-08-23 |