| NPI | 1912560186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022029881) |
| 208M00000X Hospitalist (Licence: MO 2022029881) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-04-04 |