| NPI | 1720424542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX T6345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 13970) |
| 207R00000X Internal Medicine (Licence: NE 30222) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2022-10-26 |