| NPI | 1194726521 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0101239816)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0061998)  | 
| Enumeration Date | 2005-08-09 | 
| Last Update Date | 2021-06-18 |