| NPI | 1609455179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.016369) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP160) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-03 |
| Last Update Date | 2024-07-01 |