| NPI | 1962491910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MA 74216) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: RI RI5502) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2016-04-12 |