| NPI | 1942692165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: DC AA000079) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA256) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2018-02-16 |