| NPI | 1962839209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 87) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: 6906) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2024-05-14 |