| NPI | 1588017305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 58980) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 028172) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2019-11-08 |