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 |