| NPI | 1316407919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 280618) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MA 1024401) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-06-04 |