| NPI | 1215198882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME121811) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301090965) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2022-01-31 |