| NPI | 1104081314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD00011407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00011407) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2023-03-07 |