| NPI | 1720344534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0102203537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL L200550772430) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-11-08 |