| NPI | 1255862926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: VA 0101266386) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101266386) |
| 207Q00000X Family Medicine (Licence: IL 125070799) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2024-08-09 |