| NPI | 1316440951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME166857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101272200) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2025-04-10 |