| NPI | 1780278077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.147661) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171000000X Military Health Care Provider | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.147661) | |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2024-05-30 |