| NPI | 1972838191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 5668) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 1947) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2022-12-22 |