| NPI | 1770947806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101268408) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0116032509) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116032509) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2022-08-21 |