| NPI | 1356780142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 53964) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301110805) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2020-12-30 |