| NPI | 1710545587 |
|---|---|
| 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: KY 05290) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-03-01 |