| NPI | 1013356542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101260533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260533) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116026254) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2023-02-28 |