| NPI | 1689767543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MI 36456) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 36456) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-02-10 |