| NPI | 1104000496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OR MD163113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD163113) |
| 207R00000X Internal Medicine (Licence: SC 32187) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2021-07-22 |