| NPI | 1891785887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX E9005) |
| Additional Taxonomies | 193200000X Multi-Specialty (Licence: TX E9005) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2016-05-09 |