| NPI | 1124384037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX W5887) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CT 57215) | |
| 207R00000X Internal Medicine (Licence: MD 1248) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2026-08-31 |