| NPI | 1740330240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 004896) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: AL AA-830) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |