NPI | 1104204031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 036.146211) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106974) |
Enumeration Date | 2015-05-12 |
Last Update Date | 2018-07-02 |