| NPI | 1114587896 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME169691) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME169691) | 
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN34352) | |
| Enumeration Date | 2019-06-16 | 
| Last Update Date | 2025-06-25 |