| NPI | 1851720940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 007046) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA185) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2021-02-04 |