| NPI | 1639557200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2018-00647) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2018-00647) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 209728) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2023-08-14 |