| NPI | 1659074300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MO 2026012393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.082134) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-07-01 |