| NPI | 1962852657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: AZ 8139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A16403) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2019-08-12 |