| NPI | 1467541342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MA 56966) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 56966) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |