| NPI | 1922460815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: VA 0101264083) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101264083) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-02-05 |