| NPI | 1922042522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0000466) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2010-08-19 |