| NPI | 1053541797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WV 26928) |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: AZ 59498) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R71727) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2020-02-03 |