| NPI | 1740863786 |
|---|---|
| Former Name | HOOTAN VAKILIDASTJERD |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168530) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2024-08-02 |