| 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 |