| NPI | 1639581184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1703) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2014015978) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-04-27 |