| NPI | 1790774768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA MD052361L) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101273997) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX K6811) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-07-13 |