| NPI | 1720390321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: VT 135.0000052) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT0000033) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2018-10-01 |