| NPI | 1144425323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: SD 7518) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ PG PERMIT # 76497) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2014-08-06 |