| NPI | 1154732501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX S5641) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 29099) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2020-07-07 |