| NPI | 1558867911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PA OS021801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02008200A) |
| 208M00000X Hospitalist (Licence: IN 02008200A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2025-02-04 |