| NPI | 1346495397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 13192) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 39647-020) |
| 207K00000X Allergy & Immunology (Licence: MN 13192) | |
| 207K00000X Allergy & Immunology (Licence: WI 39647-020) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-25 |