| NPI | 1174714695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 65214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD 28256) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2013-09-30 |