| NPI | 1366937856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.030513) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.030513) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2021-06-23 |