| NPI | 1235558149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MS 26163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 04083) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2019-03-01 |