| NPI | 1164916854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: NE 36757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11128) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-04-22 |