| NPI | 1992136105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1673) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2013044148) |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2016-10-07 |