| NPI | 1811424740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A171905) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S3961) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10060321) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2021-08-05 |