| NPI | 1629120225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: PR 6960) |
| Additional Taxonomies | 3416L0300X Ambulance Land Transport (Licence: PR TC AMB 122) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2008-10-22 |