| NPI | 1942638325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 7717) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 006981) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2016-06-22 |