| NPI | 1770862914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S8886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT 198960) |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: MO 2017011105) | |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2022-09-22 |