| NPI | 1679560486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME14584) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0014584) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-09-28 |