| NPI | 1922362235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA OS018185) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OT014811) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2020-04-29 |