| NPI | 1629770318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA OS025563) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: PA OS025563) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-08-31 |