| NPI | 1144630369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 307295) |
| Additional Taxonomies | 2471C1106X Radiologic Technologist, Cardiac-Interventional Technology (Licence: MS 30465) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2022-08-26 |