| NPI | 1487902961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY TP398) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101266971) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.021144) | |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2020-08-21 |