| NPI | 1780324715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35.152421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.152421) |
| 207R00000X Internal Medicine (Licence: GU TLL-2025-003) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-10-02 |