| NPI | 1023744539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA 346547) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 346547) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2025-08-14 |