| NPI | 1790121648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WA MD60657233) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60657233) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2019-07-30 |