| NPI | 1003260852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 58031) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN22622) |
| 207R00000X Internal Medicine (Licence: MN 69518) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10067024) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2023-07-13 |