| NPI | 1205973583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CO 45972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 430104377) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR-45972) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-07-22 |