| NPI | 1669904256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: CA A165242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A165242) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219678) | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2024-04-18 |