| NPI | 1629450515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2018-01762) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 264484) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2019-10-16 |