| NPI | 1174058275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 88520) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 88520) |
| 208000000X Pediatrics (Licence: GA 88520) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2021-08-23 |