| NPI | 1508235730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: AZ 85-2936913) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 94-600529) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2020-10-05 |