| NPI | 1053802850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2022-00836) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.016206) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2023-01-18 |