| NPI | 1255680096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 71408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 03851) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 071468) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2019-06-20 |