| NPI | 1104354737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CT 76789) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 271190) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2024-06-06 |