| NPI | 1891254611 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WA MD61691952) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61691952) | 
| Enumeration Date | 2019-03-19 | 
| Last Update Date | 2025-08-19 |