| NPI | 1639186240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: NC 2006-01668) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 056823) |
| 174400000X Specialist (Licence: TN MD0000038125) | |
| 174400000X Specialist (Licence: AL 00024686) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2012-03-09 |