| NPI | 1225225816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.092595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61664572) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.010735) | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2025-02-27 |