| NPI | 1104222603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: OH 35135704) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.024138) |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2019-11-13 |