| NPI | 1992787089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: TX M8115) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M8115) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: LA 026361) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-04-14 |