| NPI | 1962846204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101282041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 128098) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-08-23 |