| NPI | 1548460165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA25) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 005181) |
| Enumeration Date | 2007-07-22 |
| Last Update Date | 2016-06-28 |