| NPI | 1407121601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 53772) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: IN 01075169A) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2025-12-18 |