| NPI | 1750661419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL OS12229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO2895) |
| 208D00000X General Practice (Licence: FL OS12229) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2019-02-21 |