| NPI | 1891255519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: NC 2022-01811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-01811) |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-11-25 |