| NPI | 1649531625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: CA A172489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100854) |
| 208000000X Pediatrics (Licence: MI 4301100854) | |
| 208000000X Pediatrics (Licence: CA A172489) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100854) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2024-09-25 |