| NPI | 1023166832 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 71980)  | 
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: PA MD445869)  | 
| 207RI0200X Internal Medicine, Infectious Disease (Licence: NY 230027)  | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME99953)  | |
| Enumeration Date | 2007-01-08 | 
| Last Update Date | 2024-03-20 |