| NPI | 1609214519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MO 2016023333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R9809) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2021-05-26 |