| NPI | 1700248242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 04555) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R4152) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NH 17168) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-07-17 |