| NPI | 1235124975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: WV 09719) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: PA MD0334102) |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: OH 35034976) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2014-01-24 |