| NPI | 1972063006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 64189) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 1027986) |
| 207R00000X Internal Medicine (Licence: MA 1027986) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2026-05-15 |