| NPI | 1174783633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 269284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125052002) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: MN 53439) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2021-03-30 |