| NPI | 1144753062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036152762) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 036152762) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 227887) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2021-07-12 |