| NPI | 1568572402 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TN 45843)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2002017394)  | 
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MO 2002017394)  | |
| Enumeration Date | 2006-08-30 | 
| Last Update Date | 2014-12-03 |