| NPI | 1558822577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: TX T3475) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX T3475) |
| 207R00000X Internal Medicine (Licence: TX T3475) | |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2025-11-18 |