| NPI | 1366021131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: LA 352107) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 352107) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-07-17 |