| NPI | 1972986685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: IL 036.151989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.025749) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-07-13 |