| NPI | 1659549129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 5127) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005127) |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2014-10-21 |