NPI | 1568988632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9909) |
Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA397) |
Enumeration Date | 2017-08-20 |
Last Update Date | 2024-02-13 |