| NPI | 1154866135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0102204789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102204789) |
| 208D00000X General Practice (Licence: VA 0102204789) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2023-09-07 |