| NPI | 1003556572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.151911) |
| 208M00000X Hospitalist (Licence: OH 35.151911) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-08-13 |