| NPI | 1689243297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.153499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020016538) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.253572) | |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2025-07-08 |