| NPI | 1942677919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9220) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA287) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2023-03-22 |