| NPI | 1235492455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WI 70839) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101019822) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2019-05-24 |