| NPI | 1306423298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.257479) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: GA 12946) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2026-04-15 |