| NPI | 1356086664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101279453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101279453) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101279453) | |
| 171000000X Military Health Care Provider (Licence: VA 0101279453) | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2026-05-21 |