| NPI | 1881270627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125078130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 79475) |
| 208M00000X Hospitalist (Licence: WI 83666-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-09-04 |