| NPI | 1205254679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0102205999) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04140) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2021-05-28 |