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 |