| NPI | 1538468756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1102) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 100) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2022-11-28 |