| NPI | 1134100423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD60338714) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.093118) |
| 208000000X Pediatrics (Licence: OH 35.093118) | |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: VA 0101235630) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2019-09-03 |