| NPI | 1871852301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA MD.207680) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: LA MD.207680) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2019-06-26 |