| NPI | 1962119602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A22052) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A22052) |
| 209800000X Legal Medicine (Licence: CA A22052) | |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2022-11-02 |