| NPI | 1285383364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.252651) |
| 208000000X Pediatrics (Licence: OH 57.252651) | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-07-01 |