| NPI | 1164004818 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AL 51117) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD485041) | 
| Enumeration Date | 2021-04-22 | 
| Last Update Date | 2025-07-23 |