| NPI | 1245769165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 76595) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.135409) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2024-10-21 |