| NPI | 1740492040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA MD60331969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.089402) |
| 208000000X Pediatrics (Licence: OH 35.089402) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-08-01 |