| NPI | 1588152151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MA 288224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216054) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-28 |
| Last Update Date | 2021-06-30 |