| NPI | 1255077186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.032945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.032945) |
| 208D00000X General Practice (Licence: VA 0102208285) | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-11-14 |