| NPI | 1497119382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 32042) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI EMC0001152) |
| 207R00000X Internal Medicine (Licence: OH 35.143452) | |
| 207R00000X Internal Medicine (Licence: WY 12421A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2025-10-06 |