| NPI | 1306161575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 46282) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 46282) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME131103) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2021-05-12 |