| NPI | 1841699212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NM AA2014-009) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2014027890) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-11-17 |