| NPI | 1578954178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL PA9118989) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI 219) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2024-11-06 |