| NPI | 1528311784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 45562) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 45562) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 45562) | |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2014-08-17 |