| NPI | 1922369743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A142990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301100865) |
| 208000000X Pediatrics (Licence: MI 4301100865) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2021-11-23 |