| NPI | 1639432966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: ME MD24503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251591) |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: NH 21299) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2016-00367) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-10-05 |