| NPI | 1801877691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 80665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 36255) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: MA 80665) | |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: NC 36255) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |