| NPI | 1710092259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000363) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000003) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-05-29 |