| NPI | 1699162719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.134018) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.134018) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2026-05-06 |