| NPI | 1053419341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: AL 25895) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 00025895) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-08-25 |