| NPI | 1811101512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: TX Q4693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 262983) |
| 207R00000X Internal Medicine (Licence: IL 036.124200) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2025-09-26 |