| 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 |