| NPI | 1023130242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A125200) |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: CA A125200) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083673) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-07-22 |