| NPI | 1073834974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID o-0692) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: ID o-0692) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2019-02-05 |