| NPI | 1457610784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 17072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.131380) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2021-01-11 |