| NPI | 1114109089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101250254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.096436) |
| 207R00000X Internal Medicine (Licence: VA 0101250254) | |
| 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: MD D0082658) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2024-12-13 |