| NPI | 1841854239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.250842) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.250842) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2021-05-10 |