| NPI | 1073188025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2024010255) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT224076) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-09-11 |