| NPI | 1962651414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 5428) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA31) | |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2024-07-16 |