| NPI | 1821444373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: DC AA000096) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2016) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2017-12-18 |