| NPI | 1912568577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: NM 2025-0490) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 2025-0490) |
| 207R00000X Internal Medicine (Licence: NM 2025-0490) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2026-07-07 |