| NPI | 1770695306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000333) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 4630) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-07-08 |