| NPI | 1972181469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 59331) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY TP188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2024-09-25 |