| NPI | 1043519333 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME127439) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME127439) | 
| Enumeration Date | 2011-03-25 | 
| Last Update Date | 2025-05-14 |