| NPI | 1942761473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.145539) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074021) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.145539) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-05-14 |