| NPI | 1619469095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA MT222973) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04285) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2022-08-17 |