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 |