| NPI | 1548709884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 53752) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT212397) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 53752) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2023-09-11 |