| NPI | 1790138808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 320468) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57027957) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-06-18 |