| NPI | 1912904590 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MS 21358)  | 
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL me72349)  | 
| 207RI0200X Internal Medicine, Infectious Disease (Licence: LA 015311)  | |
| Enumeration Date | 2005-06-28 | 
| Last Update Date | 2020-09-22 |