| NPI | 1992756837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 004747) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: GA 004747) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2010-09-01 |