| NPI | 1962965699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01096130A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.152042) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-07-29 |