| NPI | 1083933675 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 46276)  | 
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MN 60842)  | 
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MN 60842)  | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-22 | 
| Last Update Date | 2018-03-17 |