| NPI | 1922413699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ID O1107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-1107) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL002577) | |
| Enumeration Date | 2014-06-21 |
| Last Update Date | 2018-09-20 |