| NPI | 1902100969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WA 60642456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263669) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA 60642456) | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2018-03-17 |