| NPI | 1871856468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: GA 83351) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200765) |
| 207R00000X Internal Medicine (Licence: PA MD455209) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-04-29 |