| NPI | 1972915544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: ME MD24429) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NH 21201) |
| 207R00000X Internal Medicine (Licence: MA 259538) | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2021-09-20 |