| NPI | 1639155039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 37862) |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease (Licence: MA 37862) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |