| NPI | 1114366812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 303822) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: LA 303822) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT204691) | |
| 207Q00000X Family Medicine (Licence: LA 303822) | |
| 207R00000X Internal Medicine (Licence: LA 303822) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-02-06 |