| NPI | 1982011763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA A134143) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A134143) |
| 202K00000X Phlebology (Licence: CA A134143) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA A134143) | |
| 2086S0129X (Licence: CA A134143) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2026-07-30 |