| NPI | 1114389210 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301501320) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208M00000X Hospitalist (Licence: OH 35137164) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-03-05 |