| NPI | 1205124724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: MA 274682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 47282) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 47282) | |
| 208M00000X Hospitalist (Licence: KY 47282) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2018-08-29 |