| NPI | 1619239670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 306722) |
| 207Q00000X Family Medicine (Licence: TX Q1563) | |
| 207Q00000X Family Medicine (Licence: WA OP60880585) | |
| 207Q00000X Family Medicine (Licence: NC 2019-01587) | |
| 207Q00000X Family Medicine (Licence: NM A-1824-14) | |
| 208M00000X Hospitalist (Licence: NM A-1824-14) | |
| 208M00000X Hospitalist (Licence: TX Q1563) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2024-11-11 |