| NPI | 1447757695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 8945) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-11-30 |