| NPI | 1457552069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 132) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1558) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-02-28 |