| NPI | 1205240520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: AZ 67188) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2017015418) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2022-09-21 |