| NPI | 1770870339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1187) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000398) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2022-06-04 |