| NPI | 1992153555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: FL OS15869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15869) |
| 208D00000X General Practice (Licence: FL UO5181) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2022-03-28 |