| NPI | 1154749992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 51229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2017-0101) |
| 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-99372) | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2024-10-14 |