| NPI | 1972786630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 32623) |
| 207R00000X Internal Medicine (Licence: OH 35122234) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.014207) | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2024-05-15 |