| NPI | 1881187524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 57.245739) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.245739) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-11-12 |