| NPI | 1619597853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CT 81139) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: VA 0101278549) | |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2025-05-06 |