| NPI | 1760844740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 86868) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: VA 0102205653) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-04-12 |