| NPI | 1043751225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35.135406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57.029297) |
| 207Q00000X Family Medicine (Licence: OH 35.135406) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-06-15 |