| NPI | 1598348120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285945) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: VA 0101285945) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC ID3TXH) | |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2025-06-26 |