| NPI | 1932509940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA446) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1682) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2021-12-15 |