| NPI | 1689715567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 002179) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 002179) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2010-05-17 |