| NPI | 1659758084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25946) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208256) |
| 207R00000X Internal Medicine (Licence: MS FC7449300) | |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: LA 336386) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-05-26 |