| NPI | 1467449488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 80) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 3514) |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA83) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2021-08-04 |