| NPI | 1497265508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 22528435) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA399) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2022-10-18 |