| NPI | 1205061223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MN 55675) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A107764) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2018-04-24 |