| NPI | 1568585289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME112180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 237117) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 237117) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-08-30 |