| NPI | 1447519905 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CO DR.0064012) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2015-00600) | 
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: CO DR.0064012) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182456) | |
| Enumeration Date | 2012-05-03 | 
| Last Update Date | 2020-06-11 |