NPI | 1104357946 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL OS16413) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA OS16413) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-23 |
Last Update Date | 2022-10-26 |