| NPI | 1740280122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL ME0064234) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: NH LT-4241) |
| 174400000X Specialist (Licence: FL ME0064234) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2021-02-25 |