| NPI | 1902286909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD475580) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 294569) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 263344) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2023-01-09 |