| NPI | 1033504170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0102207269) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: OH 34.013217) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2022-08-18 |