| NPI | 1467102715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.149596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 35476) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.252643) | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-07-24 |