| NPI | 1700409455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA MD495512) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219795) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2026-07-01 |