| NPI | 1982054250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: NM MD2020-0052) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2020-0052) | |
| 207R00000X Internal Medicine (Licence: NM MD2020-0052) | |
| 207R00000X Internal Medicine (Licence: AR E-11777) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2025-08-08 |