| NPI | 1972966596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 4014) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA338) |
| 367H00000X Anesthesiologist Assistant (Licence: MO 2016017066) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2018-03-17 |