| NPI | 1871616177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 4941) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-09-11 |