| NPI | 1104139732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: TX R8147) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: IL 036.133199) |
| Enumeration Date | 2010-07-25 |
| Last Update Date | 2022-03-10 |