| NPI | 1912503848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000177) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 181) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2022-05-03 |