| NPI | 1457649501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01427) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-41195) |
| 208M00000X Hospitalist (Licence: NC 2014-01427) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-9206) | |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2022-05-04 |