| NPI | 1336569300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A15461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.006051) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2019-08-15 |