| NPI | 1881919660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CO 56862) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0056862) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2017-08-09 |