| NPI | 1962766758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0011X Internal Medicine, Interventional Cardiology (Licence: FL ME138004) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D78149) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-11-08 |