| NPI | 1457464679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000069) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 002435) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2023-04-03 |