| NPI | 1316380058 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: TX Q8428) | 
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX Q8428) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 | 
| Last Update Date | 2019-07-10 |