| NPI | 1578875662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 075770) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 9677) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2017-01-27 |