| NPI | 1326667510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR DO223828) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: OR DO223828) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-05-18 |