| NPI | 1396088878 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: MD D0081598)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0081598)  | 
| 207R00000X Internal Medicine (Licence: VA 0101266650)  | |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: VA 0101266650)  | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-02 | 
| Last Update Date | 2025-08-14 |