| NPI | 1619409752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: PR 024164) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME154735) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-10-22 |