| NPI | 1427547280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 1023723) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 68041) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05555) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2025-05-23 |