| NPI | 1578064515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA OS026185) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL23-0768) |
| 171000000X Military Health Care Provider (Licence: VA 0102205774) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2026-07-05 |