| NPI | 1750523775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-69275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 14803) |
| 208M00000X Hospitalist (Licence: ND 14803) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2022-07-21 |