| NPI | 1750648754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO182381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.054872) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2017-09-20 |