| NPI | 1598801979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL ARNP9493691) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167242) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-07-09 |