| NPI | 1083758130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: OR MD 19613) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: WA MD00025591) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2009-03-21 |