| NPI | 1861751893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000198) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2013-01-24 |