| NPI | 1013495431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A173489) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: CA A173489) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CA A173489) | |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2024-03-18 |