| NPI | 1760883003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1825) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NC 1825) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2020-08-27 |