| NPI | 1811427867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000135) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA387) |
| 367H00000X Anesthesiologist Assistant (Licence: TX 24570325) | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-04-05 |