| NPI | 1871849323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0058241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q3340) |
| 207Q00000X Family Medicine (Licence: TN 52073) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME124505) | |
| 208M00000X Hospitalist (Licence: CO DR.0058241) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2022-11-04 |