| NPI | 1003518531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.151534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.151534) |
| 208D00000X General Practice (Licence: OH 35.151534) | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-07-12 |