| NPI | 1992905897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AL 32395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 43631) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 10782697) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2020-12-04 |