| NPI | 1770946154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 312141) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: LA 312141) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-06-09 |