| NPI | 1023578176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-01179) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.015467) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2023-07-10 |