| NPI | 1023009743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MN 48043) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 090872) |
| 207K00000X Allergy & Immunology (Licence: MI 4301091187) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-12-20 |