| NPI | 1306115001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: CA C29865) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CA C29865) |
| 207R00000X Internal Medicine (Licence: CA C29865) | |
| Enumeration Date | 2011-12-26 |
| Last Update Date | 2020-04-09 |