| NPI | 1912265190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: WA MD60829082) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: OR MD171956) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2025-08-04 |