| NPI | 1609870443 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0003869) |
| Additional Taxonomies | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: FL OS3869) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-05-15 |