| NPI | 1821528134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME172511) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: TN 64641) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-12-08 |