| NPI | 1669091153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 331231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 331231) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2023-11-09 |