| NPI | 1932462140 |
|---|---|
| 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: NY 281990) |
| 207R00000X Internal Medicine (Licence: OH 35.129000) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-05-15 |