| NPI | 1609438662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: LA 332395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 332395) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2026-04-22 |