| NPI | 1568444842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA G72770) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G72770) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2011-12-29 |