| NPI | 1164689386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.092823) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.010036) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2022-10-14 |