| NPI | 1710362603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301108596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35135939) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2023-11-03 |