| NPI | 1124680905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC 88510) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045290) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2022-10-24 |