| NPI | 1790763969 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX E4853) | 
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: TX E4853) | 
| Enumeration Date | 2006-01-06 | 
| Last Update Date | 2014-03-06 |