| NPI | 1790002913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: WI 65869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 26168) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 65869 - 20) | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2017-04-16 |