| NPI | 1063416642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301074135) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301074135) |
| 174400000X Specialist (Licence: IN 01079577A) | |
| 207K00000X Allergy & Immunology (Licence: IN 01079577A) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2021-04-12 |