| NPI | 1164983011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: FL ME150965) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN29204) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-07-01 |