| NPI | 1114182110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA MD037348E) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC014009) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2022-01-30 |