| NPI | 1962026104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WI 82054-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020019019) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2020019019) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2023-07-03 |