| NPI | 1326330440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.122274) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35.122274) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-08 |
| Last Update Date | 2021-02-22 |