| NPI | 1518940469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: SC 24622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME102688) |
| 207R00000X Internal Medicine (Licence: TN 42970) | |
| 207R00000X Internal Medicine (Licence: SC 24622) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2019-07-25 |