| NPI | 1851642524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000495) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000035) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2024-05-10 |