| NPI | 1962665364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: KY 42750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R1548) |
| 207R00000X Internal Medicine (Licence: KY 42750) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2020-12-08 |