| NPI | 1508011727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000032) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2008031740) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2014-11-06 |