| NPI | 1922015296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: WA MD00048365) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI MD10415) |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: WA MD00048365) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-11-10 |