| NPI | 1558897231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 24570351) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2017016395) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2022-01-25 |