| NPI | 1790966612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MD D69720) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: VA 0116021982) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2022-09-06 |