| NPI | 1285631747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: PR 14167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 14167) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2012-10-17 |