| NPI | 1457697757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NV AA05) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA 152) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2024-08-26 |