| NPI | 1235629692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.249928) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: GA 000000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2025-10-10 |