| NPI | 1922123728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX J4319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J4319) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-02-07 |