| NPI | 1639736754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000219) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2019033080) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2023-09-11 |