| NPI | 1760003677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OH 35.152312) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020015724) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2020015724) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-07-28 |