| NPI | 1750667580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME132899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A117389) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A117389) | |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2021-11-08 |