| NPI | 1558929109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2019026266) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2019026266) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-08-05 |