| NPI | 1679735799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: MA 253097) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 253576) |
| 207R00000X Internal Medicine (Licence: MA 253097) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2018-11-01 |