| NPI | 1710563747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MA 1017946) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0104827) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-21 |
| Last Update Date | 2026-01-12 |