| NPI | 1972840312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine Infectious Disease (Licence: OH 35121712) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.121712) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2018-07-13 |