| NPI | 1326168386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: TX N9785) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: OH 58-002199) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2025-09-11 |