| NPI | 1871797084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: ME MD22000) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA MD60692752) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16485) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2019-03-11 |