| NPI | 1194213272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69867-20) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036154562) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 6673-851) | |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2024-02-21 |