| NPI | 1902125768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102203271) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MT MED-PHYS-LIC-71023) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2023-02-16 |