| NPI | 1285168971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 56992) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116031615) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2026-07-08 |