| NPI | 1891929063 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME123575)  | 
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IN 01019735A)  | 
| 207R00000X Internal Medicine (Licence: MI 4301094726)  | |
| Enumeration Date | 2009-05-04 | 
| Last Update Date | 2017-02-21 |