| NPI | 1548497126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM AA2010001) |
| 207L00000X Anesthesiology (Licence: OH 67.000154) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2017-06-05 |