| NPI | 1417328410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 7874) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2018-09-19 |