| NPI | 1396034369 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA md458050)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A130622)  | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-30 | 
| Last Update Date | 2020-06-22 |