| NPI | 1528341328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67000285) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA102) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2024-04-10 |