| NPI | 1609983766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: OR MD15711) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: WA MD00034279) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2008-03-11 |