| NPI | 1609265982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.149119) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: NY 296298-1) | |
| 207R00000X Internal Medicine (Licence: NY 296298-1) | |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2024-10-03 |