| NPI | 1902019078 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MD D73900)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 45302)  | 
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MO 2002015753)  | |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: VA 0101249172)  | |
| Enumeration Date | 2007-05-07 | 
| Last Update Date | 2012-08-13 |