| NPI | 1780983320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WI 57607) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0101258331) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: VA 0101258331) | |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 57607) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2023-04-26 |