| NPI | 1205396850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 320109-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.146741) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OK 207RG0300X) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-06-12 |