| NPI | 1689659179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 007524) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL aa-828) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2015-07-21 |