| NPI | 1669891792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: LA PGY.202720) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA PGY.202720) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2019-05-21 |