| NPI | 1366008625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U5962) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME152896) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-10-21 |