| NPI | 1699101063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000055) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2013034524) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2016-04-19 |