| NPI | 1922259308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: ZZ 5472230) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ 4008395) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2008-10-03 |