| NPI | 1770957672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL 381) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 72-17) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2017-04-12 |