| NPI | 1720388903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1171) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA72) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2020-12-30 |