| NPI | 1659336097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 27028) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 27028) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2012-09-12 |