| NPI | 1568976264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 34.015022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.015022) |
| 208D00000X General Practice (Licence: MI 5101025915) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2021-04-08 |