| NPI | 1104168673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME126193) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME126193) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2019-06-17 |