| NPI | 1720071483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PR 16780) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 16780) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PR 16780) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2012-08-30 |