| NPI | 1902234735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 45-17) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: 1544) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2014-11-05 |