| NPI | 1578710174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME 122962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD437688) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116023871) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: VA 0116023871) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2015-09-28 |