| NPI | 1740573062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 258709) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199436) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199436) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2018-06-08 |