| NPI | 1770951097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: VT 135.0000064) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000059) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2023-01-27 |