| NPI | 1104888403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 32682) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: SC 32682) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2026-02-24 |