| NPI | 1114369170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine Interventional Cardiology (Licence: MO 2021022845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036138972) |
| 208M00000X Hospitalist (Licence: IL 036138972) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 53769) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2024-11-25 |