| NPI | 1912211459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: KY 53448) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 53448) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT196800) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2023-05-22 |