| NPI | 1912252115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 56135) |
| Additional Taxonomies | 207RI0200X Internal Medicine Infectious Disease (Licence: CT 56135) |
| 2080P0208X Pediatrics Pediatric Infectious Diseases (Licence: CT 56135) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2022-07-21 |