| NPI | 1992226393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57250333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125076991) |
| 208600000X Surgery (Licence: IL 125076991) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2021-07-01 |