| NPI | 1114985454 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 48295) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: ND 12070) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2017-02-17 |