| NPI | 1972093953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61408033) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TN 62640) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-03-06 |