| NPI | 1497012116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301109335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 1497012116) |
| 208000000X Pediatrics (Licence: OH 1497012116) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2016-06-06 |