| NPI | 1659412575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 004361) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004361) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2010-02-10 |