| NPI | 1922026749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 4663) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 004663) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-11-06 |