| NPI | 1669917795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: LA 329170) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MT212321) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2021-11-16 |