| NPI | 1306253679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY TP148) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3441) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2020-06-09 |