| NPI | 1881860104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine Infectious Disease (Licence: CT TRAINING PERMIT) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT TRAINING PERMIT) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2013-03-20 |