| NPI | 1336535673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME134784) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN21086) |
| 207R00000X Internal Medicine (Licence: FL ME134784) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2024-03-07 |