| NPI | 1124381751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IN 01081921A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100740) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10052864) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-06-11 |