| NPI | 1568088474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 168) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 168-17) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-07-06 |