| NPI | 1962866020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NC 2019-01804) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 218433) |
| 207R00000X Internal Medicine (Licence: WV 35175) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2026-05-11 |