| NPI | 1609316140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101265374) |
| 208D00000X General Practice (Licence: VA 0101265374) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2023-05-15 |