| NPI | 1528410636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ND 15979) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 6473-851) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2024-05-06 |