| NPI | 1265829360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 296811) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 296811) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60569017) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2024-04-17 |