| NPI | 1588675524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 21253) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 19598) |
| 207RI0200X Internal Medicine Infectious Disease (Licence: CO 21253) | |
| 207RI0200X Internal Medicine Infectious Disease (Licence: AZ 19598) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |