| NPI | 1508251265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX T5958) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101262843) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-09-26 |