| NPI | 1316315013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2024019619) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MO 2015026454) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2024-06-17 |