| NPI | 1053807578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IA MD-47874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-47874) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351027542) | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2021-07-08 |