| NPI | 1518261825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 6032) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1151) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2022-10-24 |