| NPI | 1871054189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301507805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 67858) |
| 207R00000X Internal Medicine (Licence: OH 35C.001631) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-07-29 |