| NPI | 1487087292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO 0000047) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA197) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2015-12-30 |