| NPI | 1750365664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MA 210023) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 210023) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2012-11-28 |