| NPI | 1689115867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CT 65607) |
| 207R00000X Internal Medicine (Licence: CT 65606) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-06-02 |