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 |