| NPI | 1811200744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 48700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096876) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: HI MD17071) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2021-12-16 |