| NPI | 1942228408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000370) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301078374) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-08-06 |