| NPI | 1861573909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA7) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 002861) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |