| NPI | 1790993483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: OK 30464) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N2495) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX AA22180774308) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-06-13 |