| NPI | 1104005370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A91843) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A91843) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX U2144) | |
| 282N00000X General Acute Care Hospital (Licence: CA A91843) | |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2023-04-05 |