| NPI | 1962667931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: GA 82420) |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2019-07-22 |