| NPI | 1992717763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: SC 14159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 14159) |
| 207R00000X Internal Medicine (Licence: NC 39615) | |
| 207R00000X Internal Medicine (Licence: IA 25618) | |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: NC 39615) | |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: IA 25618) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2012-08-17 |