| NPI | 1558682567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.120488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 305505) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2019-09-11 |