| NPI | 1124471685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 1013557) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS019927) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017102) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2025-03-14 |