| NPI | 1851895023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-01970) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 313415) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 64024) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2024-02-14 |