| NPI | 1497906754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA20) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL AA20) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2016-07-13 |