| NPI | 1104232412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-47157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.129910) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2020-07-08 |