| NPI | 1639480122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MD D92080) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101250229) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2025-12-30 |