| NPI | 1215925441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: AZ 24745) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ AZ4503) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-08-09 |