| NPI | 1306269485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 77412) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: GA 77412) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2017-08-29 |