| NPI | 1679861611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 50261) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: RI LP02232) |
| 202C00000X Independent Medical Examiner (Licence: MA 258564) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2022-10-04 |