| NPI | 1477717841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME127196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N2072) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2018-11-13 |