| NPI | 1629604517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 73185) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MN 73185) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG212617) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-07-05 |