| NPI | 1750949822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: SD 18173) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SD 18173) |
| 208000000X Pediatrics (Licence: KS 94-09945) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2026-07-09 |