| NPI | 1710410477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.141366) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.141366) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35.141366) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2022-09-13 |