| NPI | 1255821856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-137442) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35-137442) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2020-03-24 |