| NPI | 1902133846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA453) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA51) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2019-10-17 |