| NPI | 1821171794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: VT AAA0000021) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 002862) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-03-28 |