| NPI | 1922617448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.015946) |
| 208D00000X General Practice (Licence: OH 34.015946) | |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2022-07-05 |