| NPI | 1629526462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 008105) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 8105) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2021-08-18 |