| NPI | 1174578306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PR 15908) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15908) |
| 208D00000X General Practice (Licence: PR 15908) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2016-04-12 |