| NPI | 1184246191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: IL 036.161630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.161630) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-076-375) | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-06-27 |