| NPI | 1780603647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 211239) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VT 042-0011576) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2009-03-23 |