| NPI | 1083052252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VT 042-0014796) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2020-07-09 |