| NPI | 1003040676 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 263385) | 
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 255919) | 
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: MA 255919) | |
| Enumeration Date | 2009-05-11 | 
| Last Update Date | 2018-04-11 |