| NPI | 1619408648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: AZ 70093) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 70385-20) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: OH 35.145143) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-01-11 |