| NPI | 1801264353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 54830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108352) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 276250) | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2021-08-26 |