| NPI | 1780991547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME102118) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME108112) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2019-12-04 |