| NPI | 1053346866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: PA MD069874L) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital Critical Access (Licence: NJ MA56908) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-04-11 |