| NPI | 1699117499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67000246) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1524) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2015-05-07 |