| NPI | 1356609663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 126230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 129759) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-01-28 |