| NPI | 1871828863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34010510) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58-003267) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2020-11-24 |