| NPI | 1811185887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: UT 5142893-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55622) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2021-11-18 |