| NPI | 1962834192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1607) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA265) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2018-06-05 |