| NPI | 1083162580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME133199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 55768) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2021-02-26 |