| NPI | 1831466648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IN 02005067A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34011212) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH TN505962) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2023-03-07 |