| NPI | 1992067698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MA 262415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252477) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2021-05-12 |