| NPI | 1053810135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MO 2025013322) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 30257) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2025-07-23 |