| NPI | 1942686316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: DC AA000080) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 7680) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2020-02-06 |