| NPI | 1578124970 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WI 84231-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301507733) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045428) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2024-11-06 |