| NPI | 1104270354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 68552) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208M00000X Hospitalist (Licence: MT MED-PHYS-LIC-75122) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2022-01-03 |