| NPI | 1427175330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VT 042-0012261) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301085778) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MI 4301085778) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: VT 042-0012261) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2011-09-04 |