| NPI | 1760815526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000211) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA179) | |
| 367H00000X Anesthesiologist Assistant (Licence: TX 1655) | |
| 367H00000X Anesthesiologist Assistant (Licence: IN 75000007A) | |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2024-01-09 |