| NPI | 1982151353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA447) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 8171) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2018-04-25 |