| NPI | 1063754596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 207713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.207713) |
| 208600000X Surgery (Licence: LA 207713) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2024-04-04 |