| NPI | 1790455871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2025-02450) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL21-0697) |
| 208000000X Pediatrics (Licence: NC 2025-02450) | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2025-12-16 |