| NPI | 1972640225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: WY 984) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NY 285157) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1298) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-06-29 |