| NPI | 1124470497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.153292) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T6563) |
| 207R00000X Internal Medicine (Licence: IN 01083082A) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 267290) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2025-07-02 |