| NPI | 1083902761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MI 5101018688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018688) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI L2016112) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2020-12-01 |