| NPI | 1962031955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A187340) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.146412) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-05-28 |