| NPI | 1003801903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 76633) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 242450) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2015-02-09 |