| NPI | 1568658201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MN 55192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35090449) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2021-03-11 |