| NPI | 1861883563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NV 28881) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TN 71854) |
| 207R00000X Internal Medicine (Licence: IL 125070082) | |
| 207R00000X Internal Medicine (Licence: FL TRN28047) | |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2026-08-07 |