| NPI | 1952782567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CT 71523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03522) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2022-08-11 |