| NPI | 1346788155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL OS16582) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO3899) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO3899) | |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2020-06-01 |