| NPI | 1801178645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: SC 83367) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MT MED-PHYS-LIC-62346) |
| 207R00000X Internal Medicine (Licence: CO TL-4238) | |
| Enumeration Date | 2011-09-19 |
| Last Update Date | 2021-06-07 |