| NPI | 1457348054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2006034494) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL aa-807) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-01-10 |