| NPI | 1356515142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 45367) |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: KY 45367) | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2021-03-09 |