| NPI | 1104350180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2019043911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019043911) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2020-06-03 |