| NPI | 1841296670 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME0063353) | 
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL ME0063353) | 
| Enumeration Date | 2005-06-27 | 
| Last Update Date | 2025-04-04 |