| NPI | 1225488992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MI 4301110004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301110004) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110004) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-02-05 |