| NPI | 1710146725 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MI 5101017583)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101017583)  | 
| Enumeration Date | 2008-06-04 | 
| Last Update Date | 2022-07-21 |