| NPI | 1811646169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00458) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 2025-00458) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2025-00458) | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2025-09-25 |