| NPI | 1386867646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OK 27700) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 27700) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.009276) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2016-10-12 |