| NPI | 1669824199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2025036087) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR E-12977) |
| 207R00000X Internal Medicine (Licence: MO 2025036087) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2025-10-13 |