| NPI | 1336128792 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME99750)  | 
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35058304)  | 
| Enumeration Date | 2006-01-13 | 
| Last Update Date | 2025-04-15 |