| NPI | 1861979924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245666) |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2023-10-20 |