| NPI | 1164490330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 2021-01998) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: LA 020599) |
| 208D00000X General Practice (Licence: NC 2021-01998) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-11-03 |