| NPI | 1669693867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: LA 206940) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2008081401) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2017-01-30 |