| NPI | 1750562724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME120716) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: MD D73083) |
| 207R00000X Internal Medicine (Licence: LA MD.210398) | |
| 208000000X Pediatrics (Licence: LA MD.210398) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2016-04-18 |