| NPI | 1053519785 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TN 53648) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL30104) | 
| Enumeration Date | 2007-07-03 | 
| Last Update Date | 2022-01-27 |