| NPI | 1871000810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO 88) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2017043848) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2019-01-28 |