| NPI | 1922591700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101271451) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: LA 344468) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2025-02-18 |