| NPI | 1528501129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA719) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2016038653) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2022-03-17 |