| NPI | 1669774295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: OH 35133705) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD042958) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2018-04-23 |