| NPI | 1538105044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 3365) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 003365) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-10-25 |