| NPI | 1790171890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 080393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS14393) |
| 207R00000X Internal Medicine (Licence: GA 080393) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2019-09-26 |