| NPI | 1154815553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: SC 96881) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 430111491) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-06-14 |