| NPI | 1255787040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 05664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-01451) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY TP680) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2023-10-25 |