| NPI | 1326665654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0075884) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.253139) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2026-03-06 |