| NPI | 1114454709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: OH 35.148067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301112410) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.250050) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2023-10-20 |