| NPI | 1518451962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 68069) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 68069) |
| 208M00000X Hospitalist (Licence: CT 68069) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-07-27 |