| NPI | 1063873180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0101270922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101270922) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2021-07-11 |