| NPI | 1962515874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MN 61394) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00045336) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2024-01-05 |