| NPI | 1376927467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1019711) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.026491) |
| 207R00000X Internal Medicine (Licence: AZ 56222) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2024-08-27 |