| NPI | 1841712460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: NC 2026-02943) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: SC 83374) | |
| 207R00000X Internal Medicine (Licence: FL UO3596) | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2026-07-22 |