| NPI | 1891289138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WI 74726-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 74726-21) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125073220) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2021-06-27 |