| NPI | 1104842061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101230219) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 001293) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35.128475) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2026-01-22 |