| NPI | 1669715116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0116030264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34011732) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-06-29 |