| NPI | 1326568643 |
|---|---|
| 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 34.016008) |
| 208000000X Pediatrics (Licence: OH 34.016008) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2024-10-02 |