| NPI | 1104024231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2010018938) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT189901) |
| 207R00000X Internal Medicine (Licence: MO 2010018938) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2017-05-08 |