| NPI | 1295467074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-01187) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.253670) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-06-20 |