| NPI | 1164510566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL OS9317) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO1132) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-10-12 |