| NPI | 1285640896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 25392) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036109211) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2009-04-13 |