| NPI | 1356896724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 91061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD469078) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2022-07-05 |