| NPI | 1245483965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MA 253841) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2008-10-25 |
| Last Update Date | 2021-09-29 |