| NPI | 1790231025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301503738) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: WV 28246) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2022-01-03 |