| NPI | 1558744474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX V9187) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 036175101) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35.136358) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301108028) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2026-08-19 |