| NPI | 1255315495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: KY 49027) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WA MD00040562) |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: OR MD212735) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2022-10-04 |