| NPI | 1477761104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME149342) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301084640) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2023-02-10 |