| NPI | 1508852617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: AL AA801) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL aa-801) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2014-02-24 |