| NPI | 1164497129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MT 90027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61021963) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2020-09-25 |