| NPI | 1417526757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20425) |
| 208D00000X General Practice (Licence: CA 20425) | |
| 208M00000X Hospitalist (Licence: CA 20425) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2024-07-15 |