| NPI | 1104890003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: TN 17226) |
| Additional Taxonomies | 207RP1001X Internal Medicine Pulmonary Disease (Licence: OH 35065588) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2014-01-16 |