| NPI | 1578010773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 62975) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P33498) |
| 207R00000X Internal Medicine (Licence: AL 46478) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AL 46478) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CT 62975) | |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2025-09-29 |