| NPI | 1720072010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 2104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 0002104) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2023-02-22 |