| NPI | 1235193145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AZ 64152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 64152) |
| 174400000X Specialist (Licence: OH 35.046352) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-16 |