| NPI | 1750394516 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 27834)  | 
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: IN 01039387A)  | 
| Enumeration Date | 2006-08-14 | 
| Last Update Date | 2007-07-09 |