| NPI | 1952836678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI 24209) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101265225) |
| 208M00000X Hospitalist (Licence: HI 24209) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2024-10-15 |