| NPI | 1356756795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101268593) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WV 29563) |
| 282N00000X General Acute Care Hospital (Licence: PA MT207582) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2021-09-14 |