| NPI | 1417574450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9112833) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL PA9112833) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: FL PA9112833) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-07-02 |