| NPI | 1053645960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35.127822) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH NA) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2021-01-15 |