| NPI | 1780939967 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IL 036166061)  | 
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A142868)  | 
| 207R00000X Internal Medicine (Licence: IN 11016597)  | |
| Enumeration Date | 2012-07-13 | 
| Last Update Date | 2023-07-28 |