| NPI | 1619351376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: PA OS020791) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: CT 72380) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2022-10-11 |