| NPI | 1861767733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: SC 37267) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 37267) |
| 207R00000X Internal Medicine (Licence: PA MD446549) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2018-03-15 |