| NPI | 1366732117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NM MD2017-0897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2017-0897) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2011-0333) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2018-03-20 |