| NPI | 1770591554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 4215) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 004215) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-07-26 |