| NPI | 1174012132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: MI 5101028747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014756) |
| Enumeration Date | 2018-05-05 |
| Last Update Date | 2025-08-19 |