| NPI | 1366649758 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME114863) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 002440) | 
| Enumeration Date | 2007-06-28 | 
| Last Update Date | 2013-05-20 |