| NPI | 1891222725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: VA 0101286142) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI CLP05893) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-07-31 |