| NPI | 1639413636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: VT 042.0016158) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VT 042.0016158) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2022-09-07 |