| NPI | 1023645611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: UT 6540627-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 57296) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-07-24 |