| NPI | 1790969137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: FL ME108818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 001522) |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: SC LL31152) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2025-08-21 |