| NPI | 1952629990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MD 0074153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD 0074153) |
| 171000000X Military Health Care Provider (Licence: MD 0074153) | |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2023-08-03 |