| NPI | 1396974259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-123701) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-123701) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301094227) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2017-08-08 |