| NPI | 1902112006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: LA 330788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096509) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301096509) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2023-05-19 |