| NPI | 1114103124 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: CA A99653) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A99653) | 
| Enumeration Date | 2008-01-21 | 
| Last Update Date | 2025-09-02 |