| NPI | 1275851586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NY 269298) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP01893) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 269298-1) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2021-04-02 |