NPI | 1619099306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: LA 058866) |
Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: LA 01891) |
Enumeration Date | 2007-04-04 |
Last Update Date | 2007-07-08 |