| NPI | 1932804374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: SC 89733) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL89733) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2026-07-23 |