NPI | 1275910275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME147777) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2018-01175) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 209761) | |
Enumeration Date | 2015-04-29 |
Last Update Date | 2021-07-21 |