| NPI | 1922504752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: MO 2021021957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021021957) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 94-09571) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-05-08 |