| NPI | 1700145265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: CA A128872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A128872) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2018-09-18 |