| NPI | 1669983854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000214) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2023-06-26 |