| NPI | 1043605496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.013256) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: OH 34013256) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2019-05-20 |