| NPI | 1609294602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 130258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME149760) |
| 207R00000X Internal Medicine (Licence: OH 130258) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2024-03-01 |