| NPI | 1437610680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 333785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57247659) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.247659) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049651) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2024-01-23 |