| NPI | 1083605646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 37456) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MA 37456) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |