| NPI | 1821379488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA150) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: AL 1283) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2021-12-14 |