| NPI | 1124714217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2026-04105) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: NC 2026-04105) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2026-07-22 |