| NPI | 1033352109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-094998) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.012842) |
| Enumeration Date | 2009-04-19 |
| Last Update Date | 2021-12-29 |