| NPI | 1912341264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: KY 52453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC TL 39349) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63296) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-11-27 |