| NPI | 1851396345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: LA 05598R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD05598R) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2014-09-26 |