| NPI | 1417977992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 107415) |
| Additional Taxonomies | 207RP1001X Internal Medicine Pulmonary Disease (Licence: CA 107415) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2011-01-07 |