| NPI | 1881679397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: WA MD60002235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60002235) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: RI MD11639) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2018-06-29 |