| NPI | 1699126946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: SD 13359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R10724) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: SD 13359) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 04512) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-09-02 |