| NPI | 1326571878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.013997) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 00000000000000) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2021-07-23 |