| NPI | 1689624397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 004644) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 004644) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-09-03 |