| NPI | 1174683007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA MD60292569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 060-0003284) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: AK 6473) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2014-03-28 |