| NPI | 1811489891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IA DO-05778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018282) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2021-07-01 |