| NPI | 1710953666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301078860) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MI 4301078860) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MI 4301078860) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2017-10-30 |