| NPI | 1710362603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WI 86924-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35135939) |
| 207R00000X Internal Medicine (Licence: WI 86924-20) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2026-07-01 |