| NPI | 1225063951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX D7899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D7899) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-08-13 |