| NPI | 1568982106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 1021478) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63833) |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2025-08-18 |