| NPI | 1679875892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35.127477) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT197685) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101273900) | |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2023-11-03 |