| NPI | 1114305505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101267336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-01910) |
| 207R00000X Internal Medicine (Licence: VA 0101267336) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2019-12-13 |