| NPI | 1679776223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MN 53941) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101242621) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019093) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2018-04-27 |